Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Medicine, Emory University, Atlanta, Georgia, USA.
J Am Coll Cardiol. 2023 Aug 22;82(8):735-747. doi: 10.1016/j.jacc.2023.05.064.
Nonischemic cardiomyopathy (NICM) is common and patients are at significant risk for early mortality secondary to ventricular arrhythmias. Current guidelines recommend implantable cardioverter-defibrillator (ICD) therapy to decrease sudden cardiac death (SCD) in patients with heart failure and reduced left ventricular ejection fraction. However, in randomized clinical trials comprised solely of patients with NICM, primary prevention ICDs did not confer significant mortality benefit. Moreover, left ventricular ejection fraction has limited sensitivity and specificity for predicting SCD. Therefore, precise risk stratification algorithms are needed to define those at the highest risk of SCD. This review examines mechanisms of sudden arrhythmic death in patients with NICM, discusses the role of ICD therapy and treatment of heart failure for prevention of SCD in patients with NICM, examines the role of cardiac magnetic resonance imaging and computational modeling for SCD risk stratification, and proposes new strategies to guide future clinical trials on SCD risk assessment in patients with NICM.
非缺血性心肌病（NICM）很常见，由于室性心律失常，患者有早期死亡的巨大风险。目前的指南建议对心力衰竭和左心室射血分数降低的患者进行植入式心脏复律除颤器（ICD）治疗，以降低心源性猝死（SCD）的风险。然而，在仅由 NICM 患者组成的随机临床试验中，初级预防 ICD 并未带来显著的生存获益。此外，左心室射血分数对预测 SCD 的敏感性和特异性有限。因此，需要精确的风险分层算法来确定那些 SCD 风险最高的患者。本文回顾了 NICM 患者发生心律失常性猝死的机制，讨论了 ICD 治疗和心力衰竭治疗在预防 NICM 患者 SCD 中的作用，研究了心脏磁共振成像和计算模型在 SCD 风险分层中的作用，并提出了新的策略来指导未来关于 NICM 患者 SCD 风险评估的临床试验。
